Articles: analgesia.
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Scand J Thorac Cardiovasc Surg · Jan 1992
Randomized Controlled Trial Clinical TrialContinuous extrapleural intercostal nerve block and post-thoracotomy pulmonary complications.
To evaluate the effects of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary complications, a randomized, double-blind, placebo-controlled study was conducted on 80 patients undergoing elective thoracotomy for pulmonary (n = 47) or oesophageal (n = 33) procedures. In patients who received continuous bupivacaine infusion, the requirement for intramuscular opiate and rectal diclofenac was less, the score on a visual linear analogue pain scale lower and recovery of pulmonary function more rapid than in saline-infused controls. ⋯ Among the patients without COAD there was no significant intergroup difference in such complications. We conclude that continuous extrapleural intercostal nerve block is effective for post-thoracotomy analgesia and reduces pulmonary complications of thoracotomy in patients with COAD.
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Langenbecks Arch Chir · Jan 1992
Review[Acute pain in surgery: the significance of a neglected problem].
Acute pain represents a significant problem in surgical patients. However, the management of acute pain in Germany is unsatisfactory, mostly because surgeons are not interested in the pain of their patients, and anesthesiologists do not give pain treatment on surgical wards. The aim of this article is therefore to point out the significance of the problem of "acute pain" for surgeons. ⋯ It is not sufficient to know the methods and advantages of appropriate management of acute pain; one must also understand the dangers. Problems caused by the treatment of pain should be recognized from a clinical point of view. Surgeons must take a greater interest in the problem of "pain", which should lead to the establishment of new concepts in the management of acute pain in surgical patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled versus conventional analgesia for postsurgical pain relief in adolescents.
We performed a randomized nonblinded, cross-over comparison of patient-controlled analgesia (PCA) with conventional intramuscular analgesia in 10 adolescents (13-18 years) undergoing spinal fusion for idiopathic scoliosis. PCA use afforded more effective pain control (p < 0.02) on a 10-point linear pain intensity scale than did intramuscular injections, while causing an equal amount of sedation and no side effects. PCA appears to be a promising technique for providing postoperative pain relief in this group of adolescents. Further studies are needed to define its role for other pediatric conditions.
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Ann Fr Anesth Reanim · Jan 1992
Randomized Controlled Trial Comparative Study Clinical Trial[Patient-controlled analgesia: effect of adding continuous infusion of morphine].
This double blind study aimed to assess the effects of a continuous intravenous (i.v.) infusion of morphine added to an intermittent bolus patient controlled analgesia on morphine demand and related side-effects. Patients scheduled for abdominal and thoracic surgery (ASA 2 or 3) were randomly allocated postoperatively to three groups (n = 10 each): group 1 were given i.v. boluses of 2 mg of morphine (lockout interval = 15 min); the other two groups were given the same boluses as well as a continuous i.v. infusion of either 1 mg.kg-1 of morphine (group 2) or 2 mg.kg-1 (group 3). Pain was assessed with a visual analog scale before starting analgesia, and after 1, 2, 3, 4, 8, 16, 24 and 36 h. ⋯ Total amounts of morphine were higher in groups 2 (56.8 +/- 23.8 mg) and 3 (116.2 +/- 41.8 mg) compared with group 1 (38.2 +/- 17.8 mg) (p < 0.05). Morphine administration was stopped in 5 patients in group 3 and in 1 in group 2 because PaCO2 had risen to more than 45 mmHg. Therefore, a continuous i.v. infusion is not required in patients receiving PCA, all the more so as this has deleterious respiratory effects.
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Cahiers d'anesthésiologie · Jan 1992
Review[Patient-controlled analgesia by the peridural route and classical methods of analgesia].
Patient controlled analgesia was developed to compare drug effects. Later its psychological implications were studied. Drug administration by intravenous or epidural injection has been used. ⋯ Simultaneous use of opioids and anti-inflammatory drugs enhances the analgesic effects. For pain relief in childbirth, opioids need to be combined with local anaesthetics for best results. Little has been achieved by patient controlled analgesia in the treatment of chronic pain.